With talk of repealing health care in the air, I thought it would be a good time to look at a couple New England states going in the opposite direction: Vermont and Connecticut. Both of them are in the midst of designing or recommending alternatives to the private health care market, which could go all the way up to a single payer program.
First, in Connecticut, as Jon Walker described this week, the Board of Directors of SustiNet has put together for the state legislature a concept for a Basic Health program that would cover Connecticut low-income residents who make up to 200% of the Federal Poverty Level (FPL). Maria Cantwell put into the Affordable Care Act the option for states to create a Basic Health plan, which operates in a similar way to a public option, providing a higher-level product than the subsidized insurance exchanges, at a lower cost to the individual and the government. The Connecticut Post has a story today about this plan:
A long awaited state health care reform plan that could cover more than half of the state’s uninsured and save taxpayers at least $226 million a year is now headed for state lawmakers.
Last week the SustiNet Health Partnership Board of Directors unveiled a lengthy set of recommendations on how to enact the health-reform plan. The SustiNet proposal grew out of legislation passed in 2009 by the General Assembly, which formed the board and tasked it with creating a plan that would increase the quality of health care, improve access and rein in health care costs.
Among other things, SustiNet would expand coverage offered by the state HUSKY program to include adults with incomes up to 200 percent of the federal poverty level. Currently, HUSKY covers children and teenagers, parents, relatives, caregivers and pregnant women. Though Medicaid does cover childless adults and empty nesters, it only applies to those at about 60 to 70 percent of the federal poverty level, according to proponents of the plan.
In addition to expanding HUSKY coverage, the SustiNet plan will implement a variety of payment reforms and changes to health care delivery that will, according to its proposal, “move toward a more coordinated, patient-centered, evidence-based approach to health care.”
So you not only have a plan that would cover low-income residents, but it would change the health care delivery system in ways that would reduce the cost of care and save the government money. SustiNet would be rolled out gradually, and by 2014 would be open to all state residents who qualify. The incoming Governor, Dan Malloy, appears to be on board with the approach. There could be improvements to this model – particularly automatic enrollment – but in general this is a solid proposal.
Beyond the Basic Health approach of SustiNet, you have the possibility for a single payer system in Vermont. Last May, lawmakers in Vermont passed into law the creation of a commission tasked with designing three possible health care plans. The options must include a single payer system, along with an alternative that includes a state-run public option competing with private insurance.
The commission, led by Professor William Hsiao, will deliver his recommendations to the legislature on January 19, followed by a 15-day comment period. After that time, Vermont can choose one of the plans. Activists demonstrated at the Vermont State House this week to urge the legislature to take up the single payer proposal. They have the support of the new Governor:
Health-care advocates who want government-run universal coverage look at the incoming Shumlin administration with high hopes. Shumlin campaigned saying he would try to create such a system.
Although a legislative consultant has indicated that could take 12 years and eight federal waivers that require congressional approval, advocates see this as their big chance.
“The door’s open,” said Mari Cordes, president of the Vermont Federation of Nurses and Health Professionals.
All of those federal waivers are due to laws like ERISAwhich limit the steps that states can take on health care. However, there’s a possibility that under the new health care law, states could acquire an opt-out of the requirements if they show definitively that their alternative will cover as many people and not cost the federal government any more money. Senators Ron Wyden and Scott Brown have a bill that would accelerate the state waiver from 2017 to 2014, so states don’t have to comply with the insurance exchanges, only to take them down three years later. But it’s not clear whether under the state waiver, you could fold all the disparate health care programs which are funded in part or entirely by federal money folded into a single payer system.
This will be a long slog, but you could see significant movement on local health care options in the coming year. Vermont for Single Payer appears to be the main grassroots organization working on this.